1/8. kidney disease and silicosis.AIM: To determine the prevalence of kidney disease in a cohort of individuals with silicosis. methods: review of medical records and questionnaires from patients reported to a state surveillance system for silicosis. Reporting of individuals with silicosis is required by state law. All individuals with silicosis reported as required by law to the State of michigan. Individuals included in this article were reported from 1987 to 1995. Cases were reported by hospitals, physicians, the state workers' compensation bureau, or from death certificates. Only individuals who met the criteria for silicosis developed by the National Institute for Occupational safety and health (NIOSH) were included. RESULTS: medical records were reviewed of 583 individuals with confirmed silicosis. This was mainly a population of elderly men. Ten percent of the 583 silicotics were found to have some mention of chronic kidney disease, and 33% of the 283 silicotics who we had laboratory tests on had a serum creatinine level >1.5 mg/dl. An association between kidney disease and age and between kidney disease and race was found among this cohort of 583 silicotics. Individuals with silicosis were more likely to have a serum creatinine level >1.5 mg/dl than age- and race-matched controls. However, no relationship between duration of exposure to silica or profusion of scarring on chest X-ray and prevalence of kidney disease or elevated creatinine levels was found. CONCLUSIONS: This study confirms previous case reports and epidemiologic studies of end-stage renal disease that found an association between kidney disease and exposure to silica. The epidemiologic data are conflicting on the mechanism by which silica causes kidney disease and are compatible with silica being able to cause kidney disease by both an autoimmune and direct nephrotoxic effect. Chronic kidney disease should be considered as a complication of silicosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Chronic cicatrizing conjunctivitis in a patient with ocular cicatricial pemphigoid and fatal wegener granulomatosis.PURPOSE: To describe a case of chronic cicatrizing conjunctivitis in a patient with ocular cicatricial pemphigoid and wegener granulomatosis. methods: Observational case report. A retrospective study. RESULTS: An 80-year-old man presented with chronic cicatrizing conjunctivitis, peripheral corneal thinning, and wegener granulomatosis, which were diagnosed by his referring physician based on clinical (recurrent epistaxis, sinus congestion) and histopathologic features of nasal mucosa (granulomatous inflammation, vasculitis). A conjunctival biopsy performed by us disclosed features of active wegener granulomatosis and ocular cicatricial pemphigoid, which indicate lack of control of both diseases with methotrexate treatment. The patient died of pulmonary complications from Wegener granulomatosis 1 week after our evaluation. CONCLUSION: Ocular cicatricial pemphigoid and wegener granulomatosis are both potentially fatal autoimmune diseases. Ocular involvement in wegener granulomatosis indicates poor control of the underlying systemic condition and is a marker for active vasculitis, which indicates the need for treatment with cyclophosphamide.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Large vessel aneurysms in Wegener's granulomatosis.Large vessel aneurysm is not a classical finding in Wegener's granulomatosis. We describe a case report of WG complicated by subclavian artery aneurysm and review the literature on large-vessel and medium-vessel aneurysms in WG. The involved arteries included the aorta and the hepatic, renal, and left gastric arteries. In all but one case, abdominal pain was the presenting symptom. Treatment included medical and vascular interventions. In two patients, the involved vessel ruptured, leading to massive hemorrhage and death. We concluded that unexplained abdominal pain or extremity ischemia in patients with WG should alert the physician to the possibility of a large-vessel or medium-vessel aneurysm.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. The pulmonary physician in critical care * illustrative case 3: pulmonary vasculitis.The case history of a patient admitted to the ICU with severe hypoxic respiratory failure later diagnosed as Wegener's granulomatosis is presented. The diagnosis and management of patients with suspected pulmonary vasculitis is discussed.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
5/8. Wegener's granulomatosis presenting as renal mass: a case for nephron-sparing surgery.Wegener's granulomatosis (WG) is a systemic disease well recognized by physicians. The upper and lower respiratory symptoms associated with the disease are easily recognized; however, its presentation as a solid renal mass is underappreciated. We present a case of a 61-year-old man who presented with a 5.2-cm renal mass diagnosed as WG after nephron-sparing surgery. The patient presented with mild symptoms suggestive of WG, but the antineutrophil cytoplasmic antibody test was negative. The renal mass and concerns about possible malignancy obscured the diagnosis of WG. This case illustrates that WG should be considered in the differential diagnosis of solid renal masses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Wegener's granulomatosis.Wegener's granulomatosis is a rare disease of unknown etiology. Until recently it was considered uniformly fatal. family physicians should be aware of the variable presentations of this disease and keep the diagnosis in mind when faced with a puzzling, chronic, progressive multisystem process. New laboratory markers can lead to earlier diagnosis, and aggressive treatment can improve the prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Wegener's granulomatosis: case report and review of the literature.The clinical manifestations of Wegener's granulomatosis (WG) may be varied and easily overlooked. awareness of distinguishing signs and symptoms allows early recognition and appropriate management. The body of literature dealing with the various facets of this disorder has grown in the past few years. Development of new diagnostic markers and successful therapies has rekindled interest in this disease. To assure early diagnosis and optimal prognosis the physician must maintain a high index of suspicion for WG. Although introduction of immunosuppressive therapy has dramatically improved the course of this disorder, treatment-related morbidity is often profound.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Successful treatment of Wegener's granulomatosis during pregnancy: a case report and review of the medical literature.During the 18th week of a first pregnancy, a 20-year-old woman visits her physician complaining of cough, sore throat, and hemoptysis of 4 days in duration. A chest radiograph, laboratory study findings including a cytoplasmic antineutrophil cytoplasmic autoantibody titer, and lung biopsy results were consistent with a limited form of Wegener's granulomatosis. She was treated successfully with prednisone and cyclophosphamide. The remainder of her pregnancy was otherwise uneventful and resulted in a normal labor and delivery of a healthy male infant.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |